Today we publish a major report, Shared decision making: shared reality or insider jargon?

The report says shared decision making, when patients and doctors work together to decide treatment options, provides benefits to patients and the health service. But patients, and the professionals treating them, face many barriers in making it work in practice.  

Why we looked into shared decision making 

A spur to developing the report was work we did in 2018, looking into patients’ experiences of switching from biologic to biosimilar medicines: we found many had had the switch imposed on them without consultation.  We realised that even though the benefits of doctors and patients deciding together was accepted as a good thing, it just didn’t happen as often as it should.  

One barrier the report identifies is that many patients know very little about this way of working. As an organisation we’re very interested in getting more patients and doctors to use the principles of shared decision making because we believe this kind of patient partnership leads to safer care.  

We also believe shared decision making is a way of delivering care that meets the needs of patients.  Research for the report found that patients who may not know very much about health and medicine, may benefit the most: talking through options with a doctor who helps them make informed choices could significantly improve care and outcomes. We’d like to see further research into this.  

Another barrier is that some patients prefer to leave decisions to their doctors and to do as they are advised: we respect this choice. In these circumstances, it’s still essential that the patient gives informed consent for any treatment following the provision of adequate information.  

Our recommendations  

The recommendations in this report are about helping make shared decision making a reality.  

• National health leaders must address the barriers in the health system to shared decision making and champion the practice. 
• There should be greater promotion of the information and tools that exist to support patients take part in shared decision making.  
• Information and awareness campaigns that a relevant to different communities should be created.
• An audit should be undertaken of how shared decision making taught in medical schools to develop a picture of how skilled in shared decision making we can reasonably expect our present workforce to be. 
• Whether targets in the NHS Comprehensive Model for Personalised Care for making shared decision making are being met must be reported.
  

Further research  

• Our research found that people with diabetes may have poorer experiences of shared decision making: this should be investigated further. 
• What can be done that would spread the benefits of shared decision making to more patients, especially to people who typically don’t have a good experience of healthcare.  
• More work should be done to develop information used to support patients in shared decision making. 
• Further research is needed to identify whether shared decision making requires more time in, or a different pattern of, clinical appointments. 
• Future work to promote shared decision making to patients should explore raising awareness of its benefits, and the evidence that demonstrates them.
  

Next week, we look at how patient partnership helped us develop this report and what patients and doctors told us about shared decision making